Healthcare Provider Details

I. General information

NPI: 1316878051
Provider Name (Legal Business Name): GRACE MARIE FOJUT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46001 GRAND RIVER AVE
NOVI MI
48374-1319
US

IV. Provider business mailing address

3925 MORNHILL AVE
WEST BLOOMFIELD MI
48324-2858
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-3003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number5501304466
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: